Will Providers be Reimbursed for Telehealth Services?

Many providers wonder if they will be reimbursed for telehealth services as the practice becomes more common across the healthcare landscape. The quick answer is yes, it is possible for providers to be compensated for telehealth services. Medicare, Medicaid, and the majority of commercial payers all recognize the benefits and importance of telehealth and provide fee-for-service reimbursement. However, Medicare, Medicaid, and commercial payers each have different rules and regulations for what is considered telehealth and what is reimbursable for such services.

Medicare and Medicaid

The Centers for Medicare and Medicaid Services (CMS) recently updated its rules regarding telehealth-delivered services, acknowledging that the historical restrictions imposed did not capture the growing scope of telehealth services and may have been limiting the coding for some services that utilize technology in other ways.

[1] Thus, the new rules for calendar year (CY) 2019 provide reimbursement for additional services beyond what it previously approved. This means that as providers bill the designated codes for telehealth services, they will receive the designated reimbursement associated with those codes, assuming they meet all of the requirements.Under Medicaid, each state has its own rules and guidelines for telehealth coverage and reimbursement. Some states only reimburse for synchronous (live and interactive sessions) services, while others reimburse for synchronous and asynchronous (store-and-forward) services.

Commercial Payers

Commercial payers have historically been quick to adopt changes to telehealth reimbursement and are often required by the individual state through coverage parity laws to cover telehealth services within their insurance plans offered. Even though most states require private insurers to reimburse for telehealth services, the rates may vary. Some states have reimbursement parity laws, which require private payers to reimburse for telehealth services at the same rate as an in-person visit, whereas other states do not have regulations in place, leaving the reimbursement rates up to the individual payers.

[2]The fact is, telehealth is becoming an integral part of hospital and physician practice. As the drive for telehealth innovation and integration continues, payers must continuously review and update policies for reimbursement. Based on a survey conducted by American Well, 69% of physicians surveyed indicated they would be willing to use telehealth services.

[3] Physicians are beginning to understand that telehealth offers an additional source of revenue by maximizing provider productivity, and it provides patients access to care more quickly and at a lower cost. Telehealth is developing into an extension of providers that will continue to grow as payers, providers, and patients begin to reap the benefits that telehealth services can provide.

Contact us today to find out how Coker Group can help you establish an effective reimbursement plan compatible with the evolving telehealth landscape.

[1] Ray Dizon, “Big Changes in 2019 for Medicare Telehealth Policy,” National Telehealth Policy Resource Center Blog, November 6, 2018, https://www.telehealthresourcecenter.org/big-changes-in-2019-for-medicare-telehealth-policy/. May 2, 2019

[2] John D Fanburg, Jonathan J Walzman, “Telehealth and The Law: The Challenge of Reimbursement,” Medical Economics, September 12, 2018. https://www.medicaleconomics.com/article/telehealth-and-law-challenge-reimbursement. May 2, 2019.

[3] (Telehealth Index: 2019 Physician Survey n.d.) https://www.americanwell.com/resources/telehealth-index-2019-physician-survey/. May 2, 2019.

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